PREVENTION OF TUBERCULOSIS 355 



Pseudo-tuberculosis 



In 1899 the Pathological Society of London urged that this term 

 should be discarded. It is used here not as concerned with diseases 



culosis, discovered by Koch in 1882. This fungus requires to be magnified some 

 hundreds of times before it can even be seen. When it gains entrance to the 

 weakened body it sets up the disease, which is an infectious, or sub-infectious, 

 disease, though different in degree to the infectiousness of, say, measles. 



3. Trade influence and occupation, in some cases, undoubtedly predisposes the 

 individual to tubercle. Cramped attitudes, exposure to dampness or cold, ill 

 ventilation, and exposure to inhalation of dust of various kinds, all act in this way. 

 In support of the evil effect of each of these three conditions much evidence could 

 be produced. 



4. Overcrowding has a definite influence in propagating tubercular diseases. 

 The agricultural counties without large towns, like Worcestershire, Herefordshire, 

 Buckinghamshire, and Rutland, are the counties having the lowest mortality from 

 tuberculosis ; whilst the crowded populations in Northumberland, South Wales, 

 Lancashire, London, and the West Riding suffer most. Speaking more particularly, 

 the overcrowded areas of London, such as Southwark, Shoreditch, Finsbury, Hoi- 

 born, and Central London generally, show very high tubercular death-rates. 



5. Tuberculosis is not increasing. During the last thirty years it has shown, with 

 few exceptions, a steady decline in all parts of England. " Consumption " is most 

 fatal in comparatively young people (fifteen to forty-five years), whilst " tabes " 

 and other forms of tubercle are fatal chiefly to young children. These forms have 

 not declined so much as the lung form. The mortality in consumption of males has 

 since 1866 been in excess of that of females. The age of maximum fatality from 

 consumption is later than in the past, which is probably due to improved hygiene 

 and treatment. 



6. This decline lias been due not to any special repressive measures for few have 

 been carried out but to a general and extensive social improvement in the life of 

 the people, to an increase of knowledge respecting tuberculosis and hygiene, to an 

 enormous advance in sanitation, and to more efficient land drainage. 



7. Not all persons are equally liable to consumption, some being much more 

 susceptible than others. We have mentioned the predisposing influence of certain 

 trades. There is also heredity, which acts, as we have said, in transmitting a 

 tubercular tendency, rarely, if ever, the actual virus of the disease ; there is, thirdly, 

 the debilitating effect of previous illness or chronic alcoholism ; there is, fourthly, 

 the habitual breathing of stagnant, polluted air ; and, fifthly, there are the condi- 

 tions of the environment, such as dampness and darkness of the dwelling. Such 

 influences as these weaken the resisting power of the tissues, and thus afford a 

 suitable nidus for the bacillus conveyed in milk, or by the inspiration of infected 

 dust or mucus. 



8. Consumption may be arrested if taken in time. In cases where the lungs are 

 half gone, and consist of large cavities, it is obvious that curability is out of. the 

 question. But if the disease can be properly treated in its earliest stages, there is 

 considerable likelihood of recovery, or at least of arrest of the disease. 



9. The breath is not dangerous, as far as we know, but there is danger from 

 discharges of any kind from any infected part, whether lungs or bowels ; for such 

 discharges, when dry, may readily pollute the air, and either the bacilli or spores be 

 inhaled into the lungs. The breath itself in coughing, shouting, etc., may emit a 

 fine spray of mucus or saliva, in which the bacilli may be suspended, and thus 

 convey infection. 



10. The chief channels of personal infection in the spread of the disease amongst a 

 community are two: (a) dried tubercular sputum or "cough spray" (or other 

 tubercular discharges); (6) infected milk or meat. As for milk and meat, boiling 

 the former and thoroughly cooking the latter will remove all danger. In any case, 

 there is evidence to show that infection from milk or meat is nothing like so 

 common as infection from sputum or mucous particles from a consumptive patient. 



